family that they men and women cannot do that. the jesus i know was born refugee, illegitimate, with the death warrant on his name in a farm among animals. he was the ultimate minority. that is why is right for those of religious conviction to vote for this bill. ..

>> for a complete schedule visit booktv.org. >> in 2007 david gold hill's father died from an infection incurred at a hospital due to medical mistreatment. up the next, mr. goldhill, president and ceo of the game show network, contends that his father's death was avoidable and questions of the nation's health care system allows over 200,000 similar deaths due to air your this is just under an hour. >> hello everybody. we are going to get started if you don't mind. thanks to all of you for coming

here today. i am a senior fellow at the manhattan institute, center for medical progress. and we are delighted to have david gold hill join us this afternoon. for a talk about his new book, "catastrophic care: how american health care killed my father - and how we can fix it." i think that there's two, when i think about health care i think of to challenges of blind spots that i think conservatives have on health care. the first is that it tends to be liberals who criticize the critique our health care system, largely because of the large uninsured population. and the response is to say the health care system is just fine, it's the best health care system in the world, don't mess with it, don't change it. i think the second blind spot as conservatives in general but certainly in health care is that

we tend to talk about policy, public policy philosophically, or with charts and data. charts and data are important. but a lot of times the we liberals have one argument is by talking about a single mother in oregon who doesn't have health insurance and what we need to do to help her, or the child who was born with cystic fibrosis, and how that child can't get health insurance. these are real challenges in our system, and there are other challenges that people who are insured, who have coverage, who are set up in the way we all think they should be, who struggle with a convoluted mess, the extent and the mistakes that arise in our health care system. with reflection of those two things, and reflection of those two things it's not that surprising it took a lifelong democrat, david gold hill, to write cover story in the atlantic about how the american health care system killed his

father. american health care did not kill his father because david's father was uninsured. david's father had insurance. he was on medicare. but because of the unresponsiveness and all the incentives in our system that lead to the american health care system cannot really be that concerned about the patients first and foremost, david's father tragically died. unimpaired you will talk more about that when you hear his remarks. so what's really great about david gold hill's writing and david's book is that he no one talks about the real people in her system, every american who interacts with the health care system and how and seize it in a way that makes us understand how much that our system could be, but he critiques of the free market point of view. he appreciated that are so me things about health care system that could be better precisely because it doesn't skew to market principle. one of the great clichés in health care policy debate is

that health care is different. health care is somehow immune from the laws of economics that affect every other aspect of how we live. what david has done in this book is a great service in that regard in explaining how, in fact, health care is much like other sectors of the economy. david grew up in new york outside of nuke city. his father was a psychiatrist. he went to harvard college and then got a masters at nyu. he then became an investment banker doing mortgage finance at morgan stanley lehman brothers were headed frontmost seat to fannie and freddie, which something we might hear more from in the q&a. then he got involved in television and ceo of the game show network and came to help policy writing very late in life because it is tragic that affected his father. he wrote a cover story in the atlantic magazine. and turned that into a book.

it's an incredibly compelling book which i encourage all of you to buy the there's copied outside and i'm also instructed to say that the next season of american bible challenge, the game show network highest-rated show, is coming on in a few weeks of the game show network can feel like we are not stealing its ceo from his ceo duties and we are giving them a plug, too. so please join in welcoming david gold hill. i'm sure we're going to a lot from him today. [applause] >> thank you, avik. i'm sure everyone in here regional blog but it's a thrill when, as an outsider not expert, you're mentioned in something. i thank you for that, for the introduction today. thank you, everybody for coming. i am here really because of what happened to my father. it is what got me into health

care. some of you may know the story. my dad died of an infection he acquired in the hospital, a series of infections actually but it was very painful as you can imagine and for difficult experience to go through. even worse for my sister who's an emergency room physician and watched helplessly as his care was botched. about six weeks after my dad died, i read an article in "the new yorker," and read about this is a thing of you are probably familiar with that somewhere around 100,000 americans die every year from hospital infections. i'm sorry. let me start again. somewhere around 100,000 people die a year from hospital acquired infection to most of them are fairly easily preventable, not all that but most of them. doctors would design protocols to prevent them have failed to

get doctors to adopt them. i used to run a movie theater, among many of the jobs i've held for incredible short period of time, and when someone spilled a soda on the floor, we had a rule as quickly to mop it up so now we slipped and fell. when you read about an industry where 100,000 people die, and they could fix it and it wouldn't cost much, but they don't. i think the combination of the grief i felt for losing my father and assorted business man's curiosity about how other businesses are run made me wonder, why do we give this industry a pass about so much? i think all of you in this room, one of the great things about talk about health care, have been patient or have had loved ones were patient and is roughly 310 million people in this country who have a story about health care that we should say, why do we do this industry as? we would never accept this in any industry and yet we did

health care. others say it's health care. fundamentally different. what i want to talk about today is two things. one is how i it really isn't limited by the way we come to think of it is to i think it's blinding us to change in health care that's occurred since the first assumptions that guide her system and many other systems became conventional wisdom. and the second and, therefore, chilling more briefings what i think we can do about it, to begin to fix these problems. to me, the answer to the questions of why health care in this country is so expensive, so wasteful, at the same time so often unavailable to people who need it, so, delivers unbelievable at customer service that we don't even think of it as customer service is really the punchline to a number of

off-color jokes i won't help with the punchline is, because they can. antennae it's the most fundamental and important thing to understand about health care is that nobody else in your service or good trying to get your business can get away with this. they can't. someone will take your business from them. that's not the case in health care. in health care we built a system that has the most prefers incentives and outcome. more expensive care over less good character and less investment in a kind of things until you're patient customers that you care about them, service and handling of information and all the other little things. it's great in politics to find a film for this, drug companies are big insurers, or unions or whoever your villain is. but th the problem is it is beig examined health care what you find are people who are often so motivated they are -- there are

people are devoting their whole life to care of others, even in many of the evil institutions you will find lots of people got into it and are still in it because they think if they are helping others. so you have this interesting mix, a system that i regard as catastrophic in a number of ways, and people who seem to be motivated by great reasons for being there. and to me the bridge between understanding those two, the incentives in the system, the economic incentives for bad outcomes are so powerful that it overwhelms the effort to good intentions. not exactly a very politically catchy phrase, right? down with the incentives is not going to get anyone elected to power but i think it's the key to understanding how the system works. in health care we decide we don't want to be the customer. private insurers, medicare, medicaid through cms and state agencies, they are the customer.

and interestingly, it's a step back from the intricate debates about health care and ask yourself, how well does the profit incentive work in health care. it worked perfectly. the health care providers perfectly meet the demands of the circuits, which are very different from ours. i want to talk about how. let me talk about some of the biggest assumptions we have in health care. the biggest is actually reflected in our language. nobody, are almost nobody, almost nobody talks about health care practice. we'll talk about health care costs. it's interesting in the political debate about health care. you always hear the word cost as if there's some independent thing going on, a certain amount of kryptonite that provides all the health care and we only have so much of it, its price on another planet. every cost is the price of somebody's later, somebody's capital. and yet in health care, and i think it's incredibly blinding,

we think that there's a cost of things and if we can discover it and pay as little close to it, we've done well. a lot of health care policy is about discovering the cost. in the book i joke about the cost of tom cruise. so the cost of tom cruise is $20 million. tom has just about as many molecules as many of the stupid gadget has pretty much as much training as an actor that any of us to. [laughter] but none of us have any problem if you're making a movie and the cost of tom cruise because he will sell far more than $29 a ticket but that's his cost. it's also his price. tom cruise goes to work as a janitor, he doesn't get to see my cost is $20 million. because his price isn't in the field. and yet in health care if you listen how we try to regulate health care, it's about discovering that thing, that cost as if it's independent of supply, demand, technology and all of the factors that that tom

cruise's cost to $20 million. there's a lot of allusions in health care, and probably the most important dilution in health care i think is illustrated by what i would call it a tale of two women. one is the latest in the foreign. elizabeth warren argued, and i think in some ways correctly that one of the issues of the financial crisis on earth is that a lot of people applied for subprime loans without understanding what it cost them. they were misled by rates were poor documentation or bad disclosure. this is one of the things that congress did try to correct. that very same principle, hiding from us the cost of our action is the foundation of our health care system. and let me talk about a second woman, her name is becky and she's a 23 '02 just out of work for my company. so in the book come in here i'll

talk about what health care is going to cost becky. like most people in america by keeping some else's magically paying for her health care. becky issue successful. she probably will be. she's an extraordinary capable sales assistant about to be promoted to sales woman, and she probably will be very successful. becky thinks she's going to get to the top 1% of income. she also thinks she can never afford health care on her own. now, it's really a problem if the system is such that even someone in the top 1% is thinking who's paying for the other 90%? atsushi police. in fact, the health of health care increases by exactly zero from now until becky dies, becky will put $1.2 million into the health care system. if the cost of health increase is only at the rate the affordable care act estimate for the next 10 years, in other

words, if it's successful, she will put in 1.9 million. if she has a spouse who is working but becky is the breadwinner and becky provide for insurance, it will add another half a million dollars. the two of them will put two and a half million dollars into the health care system. let me mention a couple things about becky. she's entry-level, these assumptions us into the important things. she never gets rich. it's not her idea what's going to happen but it' it's statistiy likely. her income will grow two or 3% of the rest of her career. she never gets sick. the key element of our health system is is show dance. becky thinks that i am paying for her insurance. i'm not, she has. one thing that every economist left and right agrees on is that over time, not tomorrow, if becky walk in the markets to tell you what, united health insurance back, give me back the money, that wouldn't happen. overtime health insurance takes out what we're willing to compromise with our employees. i think most people now know this, it's true.

you would rather have them pay do not pay tomorrow but over time it's all coming out of what they were willing to pay. that's a big part of the. part eight we all know that part a medicare has gone up significantly. i did, she pays it. i paid on her behalf. she pays. right now 20 going up to 25 and 30% of the federal tax burden goes into subsidizing health care. 10% going to 15% of state tax burden goes to finance medicaid. the point is when you at all this money up it's a lot of money. why does it matter? the reason it matters is our health care system is so inefficient that the average person, not only could afford their health care, but would save an enormous amount of money if you transfer this money back to them and spend it to the customer. we're not going to do it but it enormous he changes your perspective on what's happening. a lot of you may be thinking that what about those who can't afford them what about those who

don't have a job? we will spend somewhere around $850 million on subsidizing medicare and medicaid. it's what we spent last year. will spend more issue. you could give 100 million americans $8500 a year with that money. a family of four, $34,000, give it to them every other life. so the fact you could take our current system, current spending to include everybody and have a complete consumer directed system. when the going to do it but we could. that's how much money we spend. the father, argued with a machete want to be called as the father our system is the 50th anniversary of an article written saying enough about health care, it's totally different than everything else. the consumer doesn't do anything. that doctors do everything it is the article for having and ensure our medicare or medicaid working on our behalf.

the problem is the article was written in 1963. before trip advisor to a lot of the asymmetric information that can air was running but is no longer the case. in fact, it's beyond just the fact that we can exchange information on the internet. it's that health care itself has changed and far more integer, far more about probability and a lot less about frankly in an auto mechanic. the problem with the engine can we fix it, you're gone. very little of health is like that but most of it is you have these alternatives, there's a variety of options been on the market every patient is encouraged to do this. but there's a bigger conceptual problem and its -- the old joke about two guys being chased by a bear in the first the one guy stops to take off issued to switch a mistake at the end is france's you can't outrun a bear. he said i don't need to outrun a bear. i need to outrun you.

the implication to which the argument has been is that because we are such terrible customers of health care, insurers will be better. we have a 50 year history of this. have acted like is? have they been as effective as us? with great misperceptions about consumer driven health care is it depends on consumers, but it doesn't. wal-mart was acquitted because and angry mob set we demand lower prices. what happened is some guy woke up one day and said i know how i'm going to make my billions. no one does that in health care. because we are not the consumer. i want to come back to this point because it's the most misunderstood thing about those of us who say we want consumer driven health care. we want consumer driven health care because consumers are idiot. ken arrow was right, we don't know anything about anything by the way. since his article that it's been in almost every industry an article about how dumb we are. just like you said was and

usually the case of health care. it doesn't matter. as a group, having people chase us, bend over backwards, to buy their product is what causes good behavior not that we are clever. i want to come back to that one. the issue really is we're terrible at it, we are worst customers of health of everyone else is worse. that's what we think we should discover to his argument is over and over again and nobody out and. not the case. the other assumption is there some objective amount of health care need. and if you look at medicare and medicaid, one of the ways they are unusual, they say, anything you need we will pay for. i'm in favor of a similar policy in cable television. because here's what would happen. if congress said we will pay for all the television you need, we would convince you all you need to watch 25 hours a day.

what's happening out there, we see it particularly in medicare, is when you tell an industry we will pay for all your customer needs, they expanded definition of needs, and the interesting thing going back to ken arrow is when a customer has actually know no skin in the game at the moment of purchase, he's more likely to say, not less like a. the consumers we are to we. the doctor tells us to do something, we will do it. this system makes it more likely. the main reason medicare and medicaid has grown so much is that. it's an economy. not to benefit us. it was entitlement to providers. to figure out ways to create any. my mother is an extremely healthy woman, i'm 52 so she is slightly -- she is 52 plus is all over now but i know she's on medicare and she is currently healthy. there's nothing wrong with it. she sees 12 or 13 doctors to

you. and a lever to press. my mother was a breast cancer survivor in middle age. got through it. when you look at the medicalization of senior citizenship that medicare has caused, one could make the argument, it's renée, that medicare is bad for seniors. i know how many of you are aware that there was a study published last year that said that one out of three medicare patients had surgery in the of their death, completely shocking. this search for an older person has for more health costs, forget about my, health cost than for anyone else. there's greater risk and there's emotional and recover issue. one out of three. one out of five, 90-year-olds in the year of their death. and everybody in health care knew how to reduce. this is a system gone amok. 40% people 35 and older in this country are taking five or more prescription drugs. some of his major good. i'm here to argue whether it's good or bad. that's not what i'm talking

about. what i'm talking about is as long as the system says whatever you need we will pay for, the definition of need will expand and, unfortunately, we will expand without reference to the whole customer, the whole patient. it expands more in reference to the industry. if you look at how we've gotten to 50% of the country having a chronic condition, i think is besit'sbest understood as indusl policy rather than health care reality. if you want everybody to nod in agreement at a conference of health experts you mention another piece of conventional wisdom that on its face we should've realized, and that is, 70% of health care expense in any given year are spent by the 10% of a population that most needs it. everyone knows what that means. that's unusually intensive use, 70% of all, just 10% of the

people. and as far as i know, no one in health care ever asked what about other industries? industries? what's interesting if you look at health care issues and expensive good and service, that 70% is probably the least instance of use there is. under 10% of of the stock 100%f the cause in any given year. under 10% of have a wedding in the given you. under 10% our attending college in any given year. under 10% of us will buy a refrigerator in any given you i can go on forever in fact maybe to tell the rest but, i should do that, but there's something very important about what i call island thinking which is as far as i know, when i search on health care this blog all the time. no one has said wait a minute, what makes health care unusual is in any given year 30% of the money or for those of us who like to think in dollars, a near

$800 billion is spent by the 90% of us who are not sick. it's literally the exact opposite of what this conventional wisdom is. i'll take it even further. they key phrase is in any given year. in health care all the houses are going to burn down. said, true but i hope i'm not the one i should bring this to people's attention, but a very large% of us in this room are going to be in that 10% for two years of our lives. now, what makes health care different is that some small% of the population is in that 10% for much of their lives. but that's an argument for ensuring that. the fact that you are, your house burns down is not an argument for ensuring your furniture wearing out. and the problem in health care

is that everything we talk about is as if there's just one way, there's one answer. there should be just one way paying for health care. so we take the most extreme examples which will affect very few of us and use it to cover the bulk of the economy as if we regular restaurants according to the needs of those who are starting. and -- starting. one can argue we need help us or in the that 10% for many years of their lives. but that's different from saying that system should fund $800 billion spent by the other 90% every single year. my debts bill for the hospital killing him was $636,687, and my mothers share with $990, which she didn't pay. if you're in business you know the bill is a very important communicating with a custom.

what is this bill saying? this is your lucky begun medicare. because none of the prices in the bill their resumes to anything medicare pay. the prices make no sense whatsoever. they have no meaning to to do so i said what if i moved down out of the hospital put him at the four seasons? got positions than two hours a day with them, that would be $150,000, taken out of the hospital and read great experience in the most expensive hotel in town.

that was over $500,000 in miscellaneous supplies. i'm not complaining that we only had to pay $990 but i am pointing out that if you ever receive health care bill from your insurer, from medicare, anywhere, it's all fiction. fiction is great. i'm in the entertainment business. i love fiction. the problem is people will say things like i didn't have health insurance -- i had a friend who needed an appendectomy and they charged him $10,000 for it, which is insane if you ever asked had one, but that's what the bill says. my friend how could i've ever before this without insurance. of course, his company had paid 18,000 for a year for his insurance, so if they given the money to him his son would've run out of benefits will before they run out of money. it affects the way we think about this.

my aunt got a bill from something like $400,000 per-share was 100 bucks. that sounds pretty good. except there's no $400,000. it's completely fiction. and the problem is it affects our public policy decisions but even worse, he spent time in hospitals it affects the way they things up -- they think about the business. my son needed an appendectomy, and we got as all of you have gotten, the first comment from injured was our medical examiner has determined that we cannot prefer hospital stay for acute appendicitis with rupture. we don't have enough facts to say was medically necessary. now, this is the real cost. in a consumer driven system you don't do any work. in a non-consumer driven system

you are driven insane. to get your money back. and that's part of how it works, right? that's part of what turning over being a customer to an intermediary means. one of the answers that the political system has 14 with this, well, let's reform again. let's get rid of fee-for-service or let's change the rate rates t which with a people but it always works great in part because of what congressional budget office what congressional budget office scoring is. but the interesting thing about reforming payment is like so much in health care, it's a discussion over how to handle the medicare problem, like so much in health care it's based on this enormous fallacy that an industry won't respond, that everything will stay the same. the reagan administration implemented the most important payment reform really in the history of american health care, which was to bundled payments for almost all inpatient hospital goods under what's called prospective payment

system. so you that a diagnosis, they would pay for diagnosis. and at the time which was 1983, the bulk of revenue and health care system consisted of two things. physician services, paying for doctors, and they -- day spent in hospital. let me tell you how successful this reform was to its extraordinary. the number of days in a hospital per medicare beneficiary has declined i 63% in the 30 years since the reform. the day spent in hospital total by medicare patients completing the publishing of medicare has almost doubled, declined by over 50%, the days per procedure in the hospital has declined by 50% to so whenever politicians talk about change, could you imagine greater change in basically cutting the core practice of the health care industry at the time, inpatient services, in

half. so as we know the cost of health care declined by 50%. i'm sorry. [laughter] i'm sorry. i get excited about successful reform, and i miss a couple of lines. so you to cut demand for somebody's product per day by 50%, were told by 50%, you must have crushed them. here's what actually happened. the average amount of medicare reimburses per day in a hospital has grown by five times since 1983. so 60% decline in the number of patients, five times increase in the price. you should all be so lucky. i want to be in that business. there's another statistic which is entirely sort of irrelevant but fascinating. hospitals tell medicare what their costs are, so that medicare can compare the price

they paid to hospitals costs. so in those 30 years that medicare increased the price paid to hospitals by five times, hospitals reported that their costs had increased a times. so the interesting thing is our demand collapsed, any industry that would've been devastating, right? medicare paid five times more but the hospitals say they are now only getting reimbursed 40% of their costs, down from 70%. one of my most fun, unami to stand outside to see this, is medicare insists that hospitals perform medicare services at a loss. and that loss has been growing. you can see the number and they showed a margin the outlaws has been growing over the last decade. since patients are the bulk of our hospital patients, nobody has ever successfully explain why people are still building hospitals. because you think if you lose

money on every patient, you want to reduce volume, not increase falling. there's a lot of that in health care. there's a lot of people in health care where you go wait a minute, if i get off the island and think in terms of the real world, if gm's prices declined and have it probably wouldn't be increasing, building new factories. i want to spend one more moment on prices because -- one of the things most is understood in health, these things action guide the way human beings see service. one of the things we assume is that we pay for health care. the question is how we pay for health care. one of the argument i'm making today is to how we pay drives the type of care we are getting. at the centerpiece of government policy on health care is that medicare pays less for every service than private insurers do, and medicare pays even less. called cost-sharing on the island. cost shifting on the island, excuse me. it's almost impossible to

compare these prices, so the data i have actually seven years old, a last really good study of a single service, and it's from michigan. at the time in michigan private insurance was paying just under $800 for an appendectomy. medicare was paying $676. medicaid was paying $335. sounds like a great deal for medicaid. now, many of you have been in a cheeseburger markets. you can buy a cheeseburger at mcdonald's 4909 cents. you can go to the cheesecake factory, sit down and have a more leisurely meal and buy a cheeseburger for $11.95. you can go literally to our neighbor, mr., by a cheeseburger for $32. now, if you lived in health care, what you would say is this cost shifting between mcdonald's and bistro, here's

my fear, my fear is we're seeing three different health systems. the reason they can sell their service as a loss is because they do make it up to a package. it's one of the reasons seniors are getting ever and ever more care. as you drive prices down, you instance and industry to find ways to sell more to the same customer. and if you look at medicare customer carefully, what this means is it's hard to believe, they are not more in mcdonald's business. mcdonald's makes more money than db bistro. they will sell you but they won't give you much service to medicate him of a ton else is having. we look at medicare it's interesting. the rate of growth in medicare is services has got a. rapidly. but the album. the things that you can do high-volume testing, and certain types of surgical procedures are

going through the roof. what we think of more normal care, take a lot of time and expertise, has flattened the. and i think which is in medicaid is an industry response to lower reimbursement which is evocative business model that lets me do fault him, i'll take medicaid patients. if i don't, i won't. again, this sounds very wonky but think of what it means for the patient we think of health care as a single thing and could. can we get your health care? the affordable care act, which is put 15 million more people into medicaid. if, in fact, what we're doing is driving different types of service, then we have an issue. we were talking about how few -- so medicare will cost $600 billion this you. seniors are the best customers of the health care system. there are now gerontologist left. there's only 5000 left in the country. how's this possible? it's possible because the way to reimburse says you can get this type of care but not this type of care. when we talk about health care

we talked about health care. we don't say there's too many spinal fusion, two hip replacements, too many people on bills, there's too many -- we talk about health care as if it's a cheeseburger. but even cheeseburgers go up. my fear is what we are missing and a system is this. we are driving care decisions based on these economic incentives but it's not as subtle as the island is a this great come we're making private insurance more money. i want to spend one more second on consumer service. 50 years ago there were 20,000 computers in the world. 10 years before that this was there were 250. there are probably 100,000 people who knew how to use them. computers were extraordinarily complex.

today, almost all of us are carrying at least one on us. several have two, three, four, ma five. all of us, everywhere on earth. what happened as we all know is that everybody became really smart about computer science the we all were required to take in school. and so this product that 50 years ago only 100,000 people on earth could use cannot successfully be used by 7 billion of us but, of course, that's not true. when you hear that health care is impossibly complex for consumers, one of the things to remember is that nobody in health care can make money by making it easy for you. nobody. think about the computer. i don't understand anything about any of my computers work. i've got a lot of them. i've got three phones, laptops, tablets, a lot of us do. it's also not because there's

one that is a clear superior computer that we all must have. it's in fact because of the opposite. this most complex thing on earth, but dawn of medicare only used by nasa and the irs and ibm. it is used by all of us because nobody said to compensated for consumers. somebody said, i know how to make a living, i'm going to figure out to make a smaller and smaller. rand released a study this month that said that the $81 billion in savings we're going to get by making an investment in health i.t. produced no sales. too bad because the government put up $25 billion of the $40 billion investment. wide? why did a $40 billion investment giving everybody a box and saw for not producing savings? if you been to a hospital or doctor you can see in front of

you, right? i mention i took my son for an appendectomy last month. we walked into the see the surgeon. he had a ruptured appendix, so fortunately i filled out the form for him but i don't know what he would've done if he was an adult at the surgeon said almost certainly a ruptured appendix. let's get a quick scan to confirm it. we went to the same hospital, for force down to get a scan. and we filled out the same seven-page form. before they would see him. we made the obvious point that we filled out the form and same hospital 15 minutes before, but i know we have all been through it. we didn't have to go to the emergency room. him where just for fun, while they're waiting for room i said i wonder if i want to pay for cash what would happen? it really was the equivalent of saying i had a bomb strapped to my chest. [laughter] and i'm going to blow this

hostile and let you perform this appendectomy. the panic, the disbelief, what is cash? [laughter] >> and then, of course, because he was in pain and i thought let's slow down, this surgery was delayed because they have no computer is way of booking or tracking upwards. if someone running back and forth. he was in a lot of pain so they gave him morphine, or at least they tried to. they wrote in order for morphing. the problem was he was i would just 20 yards away from where he was going to be for an operation and it took an hour and have to fill that order. i imagine many of the people in this room have a right to views on gun control, but trust me, if my wife had been armed, this story would've had a very ugly ending.

and you see that, and what that is, is that's what i like to call the little picture. forget about the big picture. forget about his part a solvency, party doesn't exist, but let's not argue about whether it's solvent. what it is is all of us, every single one of us going into this system that we need constantly. that's been fully integrate in our lives that many people are managing lifestyle, or in extreme cases save our lives, all good things. being treated as if we shouldn't be there, we're lucky to be there at and same mistakes ranging from the eye rolling, having to fill out the same form twice, having test results loss, everyone position not talk to another, having hospital staff changeover faster and you can learn their names.

so truly tragic. when inspector general of medicare look at how good a job they were doing in reducing the rate of accidents in hospital, they discovered that one out of four medicare admissions now leads to a health problem created by the hospital. so one out of four compares to nothing. it doesn't exist anywhere else in the world. nonexistent to you can't get that risk in combat. this is so unusual, and we gave it such a pass, and on one of te reasons we give it such a pass is we let it live on this island. we don't ask in terms of the money we put into the my take a, how we are treated, how we see it perform, have a compares to a dry cleaner. we don't do that. we need to do the island back if we need to put it under the

microscope of everything else in life. we need to recognize that health care in the future is going to be part of our lives regularly. this is not a house burning down, and we need to rethink the basic personal. i think i will limit their -- i think i will leave it there if that's all right. [applause] >> thanks, david, and i can say as someone who's read the book, you can tell from his remarks extremely interesting book, and i say this not merely to be polite to our guest. it's a restricted book. i encourage you -- and its attractive. i encourage you to buy one as a. for that, let's add some questions from the audience. stanley. >> unfortunately -- [inaudible] your do you know what the average survival rate was about 50 years ago? [inaudible] of humans.

the turn-of-the-century, the average survivor was in the low '50s, now into the '80s and '90s. >> that's because of the health care we have. let's give them a little credit. spent let me make my other point. spent blanket attack but let me take the i.t. computerization if a doctor tells us the new times of day there was an article that the study that was done by rand is that computers would solve all our problems decrease costs everything from an existing one in medicine been told it's going to increase cost, the price of button and have higher level of care, we on the. that no one as the physician because we may know something that they forgot to tells that the funding was funded by ge, and i wasn't known so they sold all the computers. the hospital on that sign it,

that $140 million to implement them, and even my techie friends are crying it takes into law because it to set the computer instead of taking care of a patient at the other point i'm going to make is that amgen, a store the other day in "the new york times." had nothing to do with hospital or doctor's, that they are fined $750 million, i'm an oncologist, but they should've gone to jail the way they're pushing a product, coming in with inducements, do this, combined can make more money, changing files, putting more medicine into files so people could make the money, some the doctors should have gone to jail. but got right after this just let them use the drug again. so let's take -- you want to talk about sanitizing the i'm sorry your dad died. [shouting] specters address that issue. >> i think those are a couple very important point. one of which i agree with, which i don't.

i think the first rand study which showed the 80 billion failed for a slightly different reason. and i think they should've been obvious to us. the first rand study you can get 80 billion in savings and 40 million in investment. that's a 200% return but i don't know what anyone in the room is getting on the money. i know there are some money managers you but i'm getting less than 200%. i want to achieve with it. what landed in ask is why the industry have made the the investment itself. why would an industry that could achieve $80 billion in savings, not make it 40 billion-dollar investment, the courts investment of our lifetime. and in not asking that question they missed what was going to happen. what was going to happen is that in health care come and talk about industrial structure, not about people, nobody can monetize the billion dollars in savings. when you're dry cleaner invested in i.t., it's not because right

clean is more technologically advanced and it's not because their people are better trained. it's because losing shirts cost money. that's it. that's what all of us. and rand missed that the $80 billion in savings translates to know increase profits and losses the most technologically advanced hospital in the country is widely regarded as tantamount. intermountain has said our technology investment has caused some of between 25 and $51 a year in profits. if you don't you don't get paid to the rest of economy went i.t. helps you save money, you can pass the savings onto consumers. that's what wal-mart did. wal-mart is a technology company. so i think, whether the rand study was right or wrong is relevant. it's obvious on its face it's not going to work. because $80 billion return on $40 billion doesn't need government intervention to happen anywhere in a gun.

as w to talk about your broader point because i think it's very important you're right that lifespans have gone up a lot and are continuing to go up. but i think as most people in the audience know, while some amount of that is attributable to personal health care, much greater amount is attributed to public health. and it's far greater amount is a trivial to lifestyle. what's interesting about the last 50 years is while the one area in which we can definitively argue personal health care has increased lifespan is cardiac care. the both of improvement almost every single study has shown has been about people stopping smoking can evil dracula's, people having jobs that create fewer disabilities, and to some extent diet, some argue that it cuts both ways. there's no question do if you do compared national work, look at different country's lifespans, the difference is in health care.

personal health care is almost never measured in oecd numbers. what we measured is more -- is mortality and was addressing there's a study and use this to the number one predictor of a lifespan that is your education. what's interesting about what we've done in health care, spending eight been -- spend 18% of our health care, we have nothing left for social, all of which are likely to drive prices but i'm not putting down the docks. i'm appreciative of health care but systemically this is bankrupting us and exposing us to a variety of problems that are really extremely. spent just as reminder we are on c-span sunday to give your name and your affiliation and keep your question greek so we can get to as many questions as possible. >> john, fox business. in my television simplistic way, so what's your solution?

your wonderful speech it sounds like an argument for more consumer driven health care, more market, but i hear you're a single-payer got. >> i'm sort of combination of extreme left and extreme right. i just like extremes. i think we need national health insurance, but i think it has to be defined as catastrophic and i think interest in what has to happen over time, we need to make it narrower rather than broader. we need to be opposite of what governments tend to be which expand the mandate. we can't switch to that system today i don't believe without giving everybody the security that their house is burning down will be counted at the same time, we need to drive as much of the 2.7 trillion we're spending now back to people. whether that's getting insurance premiums down to the type of catastrophic levels were talking to some people can save a lot more the money, going into incredibly inefficient insurance system, or whether that means

turning subsidies away from we will pay for health care with all of the terrible incentives that is created to, we will give you the money to pay for health care. what i propose, john, is what i propose is working towards a system where all of us are in a single pool, catastrophic plan that is truly narrow and that has been narrowed over 20-40 year period with a bolt of our health care running for own health accounts so that the most of the customer from the point of health insurance industry is us. so that what happened to my father and son is less likely to happen because you're more likely -- that's the 150. it resumes for what they do in singapore believe in what they done in any other single-payer state. part of the argument is a healthier, more and more health care is truly non-catastrophic and our attempt to cover with insurance is taking the most expensive, most complex, most administratively difficult

former finance and applying it to things that it is just not intended for, which is not the best way. >> unfortunately we don't have much more time but it sure david will stick around but to sign books that talk to you after which the that's thinking once again for his remarks. [applause] >> thanks to all of you for coming. [inaudible conversations] >> is there a nonfiction our author you would like to see it on booktv? in the cimino at c-span.org? or tweet us at twitter.com/booktv. and bob deans is a bob deans is a director king occasion for the national resources defense council and the author of a new book, "reckless: the political assault on the american environment." tell me about your book. >> in the last two years we have seen the single worst legislative assault in our history against the common sense safeguards would all depend on to protect our air, water, wildlife, land.

we have seen more than 300 votes in the house of representatives meant to water down, undermine, delay or block altogether needed protections, and this has gone after the clean water act. the clean air act, the endangered species act. is gone after iconic places like the chesapeake bay, the appalachian mountains, the gulf of mexico. the great lakes. and it's endangering the future of our children, our health. we felt like the american people need to know about this and here's why. the american people did not ask for this reckless assault, somebody else do. the corporate polluters who spent hundreds of millions of dollars every year pumping up the campaign coffers or anybody who will take a smokestack agenda up on capitol hill. we felt like this would be told because the american people care about their future. so when people want to understand gee, why have we made progress on climate change, why have we made progress on safeguarding our people from cracking, our dinners, ranchers,

farmers but what i begin something about these threats to our future? this book tells the story of why that's happening. >> and important, the republicans have led to this assault that this is not who the republican party has been historically. and we make that point in the book. going back to teddy roosevelt, coming up to richard nixon after all who greeted environmental protection agency, ronald reagan who got the lead out of our gasoline. george h. w. bush went after acid rain the republicans have a history of responsible stewardship of our environment. the hard right turn to the party, it give it away from its own and from concert attendance picks we make that point in the book. >> you talk about the 2010 house of representatives and you focus on the republicans, but you also look at democrats in regards to the anti-legislation speak with there are a handful of democrats who sided with republicans in this assault but they tended to be from fossil fuels states. from states that are reliant on the fuels of the past to what we are trying to say is we need to

continue to invest as a country in renewable fuels, in energy efficient, and solar, and wind it and we make that case that while we're continuing to use a lot of cold in this country, a lot of oil and a lot of gas, we need to be moving towards more sustainable fuels. not overnight but over time. >> as president obama done enough in regards to environmental regulation legislation speak with president obama has worked very hard to make progress, but there's a lot more left to be done to a couple of quick examples the president obama worked hard with the automakers to double the fuel efficiency of our cars by 2025. that is going to save consumers $100 billion a year at the pump. is going to cut our carbon emissions from automobiles and have. that's good progress. but an opportunity house for a second term is to go ahead and reduce the carbon from our single largest source, which is coal-fired power plants. we need to reduce those carbon

emissions, and the epa is positioned now to issue new standards that can make a lot of progress. we all need to support it spent you wrote about the 2010 house of representatives, and as you know the 2012 house of representatives doesn't look very different. what do you think? >> it's fundamentally unchanged the complexion but we hope that republicans and democrats alike will reach across the, find common ground around ways to go after climate change, for example. we just finished the hottest summer on record in this country and went after the got the had wiped out, seek to past year lands, ranchers were liquidating the cattle herds from the rocky mountains to the ohio river valley. we hope that people of goodwill, leaders of both particle reach across the aisle and say we've got to do something about climate change. we got to do something to make fracking say for arguments, our farms, our ranges. we have got to continue to make progress on the issues that affect the health of our children. spent talking with bob